Tutlam Nhial T, Kizito Samuel, Nabunya Proscovia, Naseh Mitra, Nabbosa Imelda, Kwesiga Isaac, Namatovu Phionah, Bahar Ozge Sensoy, Nakasujja Noeline, Ssewamala Fred M
International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA.
Forced Migration Initiative, Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA.
AIDS Behav. 2025 Jun 16. doi: 10.1007/s10461-025-04789-6.
Although the prevalence of mental disorders is high among conflict-affected populations, the extent to which social determinants impact the mental health of conflict-affected youth living with HIV is not well studied. The goal of this study was to investigate how social determinants impact the mental health of refugee adolescents and youth living with HIV in Uganda (RAYLHIV). We analyzed baseline data from a two-year cluster randomized clinical trial (RCT) among RAYLHIV (ages 13-30). The participants were recruited between July and December 2023 from 20 health centers in three refugee settlements. To examine the association between selected social determinants of mental health (SDoMH) and the mental health outcomes, we fitted a separate mixed-effects linear regression model for each outcome including depression, hopelessness, and PTSD. HIV-related stigma (β = 0.04, 0.01-0.07; p = 0.012) and PTSD (β = 0.29, 0.16-0.43; p = < 0.001) were associated with increased depressive symptoms. Similarly, unemployment (β = 2.39, 0.65-4.13; p 0.007), HIV-related stigma (β = 0.20, 0.09-0.31; 0.001) and PTSD (β = 1.55, 0.84-2.26; p < 0.001) were associated with hopelessness. Good physical health (β = -0.53, -1.00-0.06; p = 0.028) and school enrollment (β = -0.94, -1.3-0.50; p < 0.001) were associated with lower PTSD symptoms. This study found that social determinants including school enrollment, double orphanhood, HIV-related stigma, poor physical health, and poverty related factors like unemployment are important predictors of poor mental health among RAYLHIV, underscoring the need for multilevel approaches to address these challenges.Trial registration: NCT01790373.
尽管在受冲突影响的人群中精神障碍的患病率很高，但社会决定因素对感染艾滋病毒的受冲突影响青年心理健康的影响程度尚未得到充分研究。本研究的目的是调查社会决定因素如何影响乌干达感染艾滋病毒的难民青少年和青年（RAYLHIV）的心理健康。我们分析了一项针对RAYLHIV（年龄在13至30岁之间）的为期两年的整群随机临床试验（RCT）的基线数据。参与者于2023年7月至12月期间从三个难民安置点的20个卫生中心招募。为了检验选定的心理健康社会决定因素（SDoMH）与心理健康结果之间的关联，我们针对包括抑郁、绝望和创伤后应激障碍（PTSD）在内的每个结果拟合了一个单独的混合效应线性回归模型。与艾滋病毒相关的耻辱感（β = 0.04，0.01 - 0.07；p = 0.012）和创伤后应激障碍（β = 0.29，0.16 - 0.43；p < 0.001）与抑郁症状增加有关。同样，失业（β = 2.39，0.65 - 4.13；p = 0.007）、与艾滋病毒相关的耻辱感（β = 0.20，0.09 - 0.31；p = 0.001）和创伤后应激障碍（β = 1.55，0.84 - 2.26；p < 0.001）与绝望有关。良好的身体健康（β = -0.53，-1.00 - 0.06；p = 0.028）和入学（β = -0.94，-1.3 - 0.50；p < 0.001）与较低的创伤后应激障碍症状有关。本研究发现，包括入学、双亲孤儿身份、与艾滋病毒相关的耻辱感、身体健康不佳以及失业等贫困相关因素在内的社会决定因素是RAYLHIV心理健康状况不佳的重要预测因素，强调需要采取多层次方法来应对这些挑战。试验注册号：NCT01790373。
